Aneurin Bevan, the Labour health minister who created the NHS 70 years ago this week, said that providing free healthcare funded by general taxation as a right was “the most civilised step any country had ever taken”. To modern ears the phrase sounds quaint, but the service continues to be an object of veneration. The Conservative politician Nigel Lawson once called it the closest thing English people have to a religion.

Bevan resigned from Attlee’s cabinet in 1951, believing that Britain’s postwar claim to “moral leadership of the world” was slipping. But the charges for prescriptions, spectacles and dentistry that were among his reasons for quitting have turned out not to be the precursors to all sorts of other fees. In Scotland, Wales and Northern Ireland, prescriptions are once again free. A Conservative prime minister has just promised NHS England a birthday gift of billions of pounds.

Today, the NHS encompasses four distinct health systems in the four nations of UK, but all are part of a precious inheritance, and recognised as such across the political spectrum. Recent data from the British Social Attitudes research centre showed that 61% of people want to pay more tax to fund the health service. Asked who should look after the sick in 2016, just 2% said private companies. Even the Eurosceptic right sees the NHS as a source of pride: hence its strange journey from Danny Boyle’s joyous Olympics opening ceremony in 2012 to the side of the Brexit bus.

Patriotism and nostalgia may be elements in our loyalty to an institution born out of the ashes of war. But it is essential to say, and keep on saying, that it is perfectly rational to feel positive about the health service. Last year the US-based Commonwealth Fund placed the NHS top of its rankings. Last week another study offered a more mixed picture, with the NHS’s strong points of equal access and efficiency highlighted alongside below-average clinical outcomes, and low numbers of doctors, nurses and beds. “A perfectly ordinary healthcare system” was the summary offered by the Institute of Fiscal Studies’ director, Paul Johnson.

But while this may be a reasonable judgment of what the NHS does, and costs, it doesn’t take account of the values it represents. Given the relentless assault on egalitarian impulses in almost every other area of public policy, it is extraordinary the extent to which, in healthcare, they cling on.

The health secretary, Jeremy Hunt, and NHS England’s boss, Simon Stevens, did well in their recent negotiation with the Treasury: the gap between the 4% a year they wanted and the 2.5% that the chancellor, Philip Hammond, was offering, was large and the final figure – an average of 3.4% a year for five years – is closer to their figure than his (new funding for the devolved health systems is likely to follow). But relief at the budget increase must not blind us to the truth that it is not enough: a sticking plaster rather than cure – let alone the forward-looking, holistic treatment the ailing service is crying out for.

The hope for the next five years is that a new funding mechanism for social care, combined with some tweaking of 2012’s Health and Social Care Act, will mean that despite demographic pressures and the shortages of both staff and medicine threatened by Brexit, the system will cope, aided by a shift away from competition and quasi-markets towards increased collaboration.

The NHS at 70: is this a time for celebration? | Letters

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The danger is that longstanding tensions will not be resolved: between the highly centralised service Labour created 70 years ago and failed to move away from in the New Labour years, and the devolved arrangements now needed in England as well as across the UK; between healthcare and social care; between hospitals and the primary and community facilities where, experts agree, a greater share of care must be delivered to an ageing population; between technocrats and the politicians who should ensure democratic accountability. If reforms are simply cover for cuts, the public will notice. Even the most dedicated managers cannot spin straw into gold. If there is no progress on targets such as waiting times, confidence will erode, while those who can quietly make private provision to protect themselves and their loved ones – cheered on by the rightwing press.

It may seem counterintuitive that as lifespans get longer and new treatments are invented, healthcare takes a larger share of resources. But this is how it is. Almost half of UK health spending is on people over 65. Worsening mental health, particularly among young people, is an area of acute concern. We need not only to talk about all this but dramatically to raise the quality of the national conversation. Surgeon and former health minister Lord Darzi has spoken of the “huge, huge, huge public engagement job to do”. It still hasn’t been done, and can’t be left to the professionals. Your NHS needs you.